The Gay Couples Study seeks to identify and examine relationship dynamics in gay couples and how those dynamics affect sexual risk behaviors with primary and outside partners. Relationship dynamics include issues such as communication, intimacy, couple serostatus, sexual behaviors, sexual agreements, safety agreements, broken agreements, and HIV testing.
The original Gay Couples Study was a single-site study that was conducted in four phases. In Phase One, the Qualitative Phase, 39 couples participated in one face-to-face, in-depth, semi-structured qualitative interview. Once analyzed, those interviews revealed common themes, many of which were integrated into a unique and original survey instrument, the Sexual Agreement Investment Scale. This scale, coupled with other psychological and behavioral measurements, was combined into one quantitative survey and pilot-tested for validity and reliability with 200 couples during Phase Two, the Pilot Phase. In Phase Three, the Cross-Sectional Phase, 450 couples were recruited to take the quantitative survey. Using a larger pool of participants, various research questions within the quantitative survey were explored in greater detail.
In Phase Four, the Longitudinal Phase, 116 additional couples were recruited and all 566 couples were followed over a three year period to monitor how and when their relationships and sexual agreements change over time. The Longitudinal Phase included two sets of additional qualitative interviews: one that explored in greater detail many of the research questions from the quantitative survey with a randomly selected subsample of 40 couples from the Longitudinal Phase and another that explored the impact of language, culture, and race/ethnicity with an independently recruited sample of 10 Spanish-speaking Latino gay male couples (Latino Gay Couples Study).
All couples participating in the Longitudinal Phase were surveyed six times over three years. The first follow-up survey (T2) occurred one year after Baseline. The four remaining follow-up surveys (T3 – T6) occurred every six months thereafter for the following two years. All couples who participated in the qualitative interviews were interviewed three times over three years, with each follow-up interview occurring one year after Baseline. Couples who participated in the Latino Gay Couples study were interviewed two times over two years, with the follow-up interview occurring one year after Baseline.
Data collection was completed for the original Gay Couples Study in February 2010.
In 2009, we applied for and received funding to extend the Gay Couples Study for an additional five years. Our objective is to further investigate three of the most compelling findings from original Gay Couples Study: exploring the other types of agreements couples make about sex, what happens when agreements are broken, and HIV testing for gay couples. The Gay Couples Study Continuation, as it is now called, begins with an exploratory Qualitative Phase, where 20 gay couples will participate in one face-to-face, in-depth, semi-structured qualitative interview. Themes from these interviews will help inform revisions to the existing quantitative survey.
Once revised, the quantitative survey will be re-launched in a new Longitudinal Phase, where 500 gay couples will be surveyed five times over approximately three years. Findings from this phase will be used to help inform a future intervention aimed at gay couples.
Previous research shows that gay and bisexual men in relationships engage in substantially higher rates of unprotected anal intercourse (UAI) with their primary partners than do single men with their casual partners. Additionally, studies differentiating relationships by partner serostatus have found that men with seroconcordant partners report significantly higher rates of UAI than men with serodiscordant partners. Although a desire for more intimacy in the relationship may contribute to couples engaging in UAI with each other, serostatus differences, in addition to the couple’s sexual agreements, present new questions and challenges for HIV prevention research.
With high rates of seroconversion among gay male couples, and primary partners an often unrecognized and under-studied source of new HIV infections, studying gay couples is an important next step in HIV research and prevention.
Initial findings revealed during the Qualitative Phase include the motivations for developing and maintaining sexual agreements, such as to support stronger, healthier, and more satisfying relationships and non-heteronormative identities; to emphasize trust, safety, love, and commitment; and, to a lesser extent, to avoid HIV and STD infection.
Agreements about whether or not to allow sex with outside partners covered a wide range of types, including monogamous arrangements as well as those that permitted sex with outside partners. For those couples who allowed sex with outside partners, most placed rules or conditions limiting when, where, how often, and with whom outside sex was permitted. How couples handled breaks in their agreements varied, depending on what condition was broken, whether it was disclosed, and the partner’s reaction. In general, disclosure benefited the relationship by giving couples the opportunity to discuss their needs and expectations and by allowing an opportunity for increased communication about and renegotiation of the agreement, if necessary.
Analysis of data from the Latino Gay Couples Study revealed participants engaging in four behaviors that may actively reduce their HIV risk: approaching sexual agreements from a practical standpoint, maintaining a high literacy around HIV, having exposure to social support groups for Latino gay men and finding support in their relationship with another Latino gay man.
Analysis of quantitative and qualitative data from the Longitudinal Phase is ongoing and several manuscripts are currently in production. Please contact the Principal Investigator or Project Director for more information.
As HIV research and prevention efforts increasingly target gay men in relationships, situational factors such as couple serostatus and agreements about sex become central to examinations of risk. Discordant gay couples are of particular interest because the risk of HIV infection is seemingly near-at-hand. Yet, little is known about their sexual behaviors, agreements about sex, and safer sex efforts. The present study utilized longitudinal semistructured, qualitative interviews to explore these issues among 12 discordant couples. Findings show that nearly every couple had agreements about reducing the likelihood of HIV transmission from one partner to the other. Negotiating these agreements involved establishing a level of acceptable risk, determining condom use, and employing other risk-reduction techniques, such as seropositioning and withdrawal. For half of the couples, these agreements did not involve using condoms; only two couples reported consistent condom use. Despite forgoing condoms, however, none reported seroconversion over the course of data collection. Additional issues are raised where long-term HIV prevention is concerned. Future prevention efforts with discordant couples should work with, rather than fight against, the couple’s decision to use condoms and endeavor to complement and accentuate their other safer sex efforts.
Agreements about sex with outside partners are common among gay couples, and breaks in these agreements can be indicative of HIV risk. Using longitudinal survey data from both partners in 263 HIV-negative and -discordant gay couples, we investigate whether relationship dynamics are associated with broken agreements. Twenty-three percent of respondents reported broken agreements. Partners with higher levels of trust, communication, commitment, and social support were significantly less likely to report breaking their agreement. Promoting positive relationship dynamics as part of HIV prevention interventions for gay couples provides the opportunity to minimize the occurrence of broken agreements and, ultimately, reduce HIV risk.
This study is made possible by grants from the National Institute of Mental Health, MH 75598, MH 65141, and MH 075598.